diseases related to nerves and muscles.ppt x

diseases relared to nerves

1. DISEASES OF NERVES

2. TRIGEMINAL NEURALGIA (Tic Douloureux ) (5 th Cranial nerve disorder)

3. Aetiology Not dental in origin Peripheral nerve injuries or tumors Atherosclerosis of superior cerebellar artery – pressing and grooving of the nerve Idiopathic (central/periphery)

4. Clinical Features Searing, stabbing or lancinating type of pain feeling like an electric shock Pain is initiated when the patient touches trigger zone Tic douloureux – spasmodic contraction of facial muscles Early stage – Dull pain Later stage – Excruciating pain Females 50 yrs Right side of face Unilateral

5. Trigger Zones Vermilion border of the lips Alae of the nose Cheeks Periorbital region Unwashed or unshaven face !!!!!

6. Differential Diagnosis Migraine Sinusitis Tumors Postherpetic neuralgia Dental pain

7. Treatment Sectioning of the nerve Injection of alcohol Phenytoin Carbamazepine Microsurgical decompression Gamma knife radiosurgery Earlier Common Newer

8. BURNING MOUTH SYNDROME Burning or stinging of the mucosa/lips/tongue Absence of any visible mucosal lesions ETIOLOGY Local causes Xerostomia Trauma Mucosal disorders GERD Oral habits Systemic causes Vit B12, folate, iron def. Medication Allergic reaction Diabetes Psychogenic

9. Clinical Features Burning sensation in tongue, lips or palate Continuous or intermittent Altered taste perception Treatment Modalities Vitamins Dietary supplements Mouthwashes Salivary substitutes Antidepressants

10. OROLINGUAL PARESTHESIA ( Glossodynia , Glossopyrosis ) Pain, burning, itching and stinging sensation Glossodynia – Painful tongue Glossopyrosis – Burning tongue Local and systemic factors are related Vitamins, antidepressants, topical anesthetics

11. GALVANISM

12. Severe unilateral headache in orbital, supraorbital, temporal or in combination Onset occurs at exactly the same time of day SPHENOPALATINE NEURALGIA ALARM CLOCK HEADACHE

13. AURICULOTEMPORAL SYNDROME / FREY’S SYNDROME Damage to the auriculo temporal nerve and subsequent reinnervation of sweat glands by parasympathetic salivary fibres

14. Cause: Post operative condition (Parotid) Damage to auriculotemporal nerve Damaged nerve regeneration Parasympathetic salivary nerve supply develops Innervation of sweat glands Functioning of sweat glands during salivary or gustatory stimulation

15. Features Flushing and sweating in the temporal region during eating Gustatory sweating while taking spicy or sour food Crocodile tears – salivary lacrimal reflex Treatment Surgical approach

16. Abrupt, isolated, unilateral, peripheral facial nerve paralysis BELL PALSY/FACIAL PARALYSIS (7 th Cranial nerve disorder) CAUSES Idiopathic Infectious (HSV) Inflammation of facial nerve Ischaemic and compressive processes

17. Clinical Features Drooping of the corner of mouth Watering of eye Inability to close or wink the eye Absence of wrinkle on forehead Mask like or expressionless face Difficulty in speech and eating

18. Recurrent attack of facial palsy Painless edema of face Cheilitis granulomatosa Fissured tongue Melkersson Rosenthal Syndrome

19. Treatment No specific treatment Vasodilator drugs eg . Histamine Surgical anastomosis of nerves Precaution for the involved eye to prevent infection

20. GLOSSOPHARYNGEAL NEURALGIA (9 th Cranial nerve disorder) Sharp shooting pain in ear, pharynx, nasopharynx, tonsil or posterior portion of tongue Unilateral, subsiding type of pain Trigger zones: Posterior oropharynx Tonsillar fossa Pain is similar to trigeminal neuralgia

21. ATYPICAL FACIAL PAIN Vague, deep, poorly localised pain in the region supplied by 5 th and 9 th cranial nerves Distribution of pain is non-anatomic, lacks atrigger zone and may cross the midline ATYPICAL ODONTOLGIA Similar to atypical facial pain but localised only to teeth

22. HORNER’S SYNDROME Miosis – Contraction of the pupil Ptosis – Drooping of the eyelid Anhidrosis and vasodilatation of the face

23. DISEASES OF muscles

24. Dystrophy Progressive degenerative disease of skeletal muscles Histologically, muscles fibres degenerates and replaced by connective tissue and fat Myotonia Failure of muscle relaxation after cessation of voluntary contraction Atrophy of muscles Weakness of facial muscles- myopathies facies / swan neck Clonus – intermittent spasm Trismus – constant spasm

25. Hypotonia Reduction or complete absence of tonus in muscles Atrophy Decrease in the size of individual muscle fibre Hypertrophy Increase in the size of individual muscle fibre Myositis Inflammation of muscle tissue Myasthenia Abnormal weakness and fatigue in muscles following any activity Disorder of muscle excitability and contractility

26. MYASTHENIA GRAVIS Acquired autoimmune disorder Characterized by weakness of skeletal muscles and fatigability of striated muscles Antibodies are directed towards acetyl choline receptor in neuromuscular junction

27. Clinical Features Muscles of facial expression and mastication are affected Dysphagia and drooping of the jaw Slurred speech Diplopia and ptosis Weight loss and weakened Respiratory failure and death

28. Drug of choice: Physostigmine ; anti-cholinesterase (immediate relief)

29. MYOSITIS OSSIFICANS Formation of fibrous tissue and bone in muscles, tendon, ligament and fascia Patient is transformed into rigid organism – PETRIFIED MAN

30. PROLIFERATIVE MYOSITIS Pseudosarcomatous process Proliferation of basophilic giant cells and fibroblasts Involves epimysium, perimysium and endomysium

31. THANK YOU

32. REVISION

33. 50 year male patient C/O sharp pricking pain on left side of face Pain is intermittent History of restoration and prosthesis 10 years back No trigger zones and dental infection noticed ??????????????????????????????

34. 55 year female patient C/O searing and stabbing pain early in the morning on right side of face Patient unable to wash her face Pain is sharp and subsides within seconds No dental infection ???????????????????????????????????

35. 35 years old male patient C/O burning sensation on his lip region Habit of smoking 20 cigarettes per day for past 10 years Associated with dry mouth ????????????????????????????????????????

36. 35 years old male patient C/O burning sensation and pain in his tongue Habit of smoking 20 cigarettes per day for past 10 years Associated with dry mouth ????????????????????????????????????????

37. 60 year old female patient C/O headache on her left temporal region Reveals previous dental history (RCT in 26 3 years back) Headache is unilateral and occurs in episodes on same time in a day ??????????????????????????????????????

38. Middle ear region Tonsillar area Posterior part of tongue ?????????????????????????????????? PAIN